amylpn24

My opinion is this. The AANAC certification is great but.....I do not believe that if you do not have any experience in the MDS, you will understand it. The best thing for you to do before taking a class such as that is get yourself an MDS 3.0 manual. Make sure it is the 3.O and not the 2.O. Get a blank MDS and study the manual from front to back so you at least have a clue what you are doing before taking a course. Completing and MDS is easy. It is the rules and regulations that are hidden in the manual that are difficult. In addition, the most important thing is learning how to calculate RUG levels and how to get the highest one. The job is about making the almighty dollar.

Well, All I can say is be glad that you have any help at all!! The only reprieve we have been able to get is "don't put the MDS/PPS Coordinators on call for three weeks". Grrrr

Don't let the 3.0 scare the life out of you. When you look at the big picture, it is not really THAT different. What is different is that now instead of interviewing the staff and forming your own opinions about what you think the residents need...you will be asking them and inputting the info. The CAA's are still RAPS. Just keep in mind that we will no longer be able to close the door and do them by ourselves. They must be worked by the entire team. This is the main preparatory measure you should take, getting them on board before October 1. Another suggestion, back up every single assessment you can into September and just leave yourself a few for the first couple of weeks of October. Read the new manual, interesting reading I know. There are some new rules but, not a lot. If you know the current system, you will do fine with the new one. Everyone is freaking out, we do not like change. I don't either but as I said, look at the overall picture, it's not that bad.

Supervision with set up. 1/1. Using your eyes is considered supervision.

I am an MDS nurse with several years of experience and thoroughly trained in the 3.0. Willing to travel, do freelance work for the right price. Hold compact license.

Time to get a new job!!! MDS Coordinators can and will have more of an opportunity in with the 3.0 to write their own ticket. Get out of there.

I believe the answer to this question depends on facility policy. We do keep the chart for 30 days and start over after that. As far as the MDS's being on the chart, I'm not quite sure what one has to do with the other. If the patient has been discharged, the file goes to med records where it is kept should the state want to pull the chart for some reason.

In this case, you would change the ARD to the day of discharge. There is nothing in the RAI that says that the MDS nurse must do an or the assessment. You just use what information that you have from his six day stay and hosptial records and answer the questions that best that you can. The powers that be are incorrect and as mentioned by someone else, they will be taking the default rate. Not wise.

All I can say is WOW! I too have a lot of additional responsibilities and it makes me crazy!! In my opinion, any administrator and DON should be well versed in MDS and realize that it is US who are generating the revenue. More time equals more time to generate revenue. I wish I knew what the answer was. Your responsibilities go WAY beyond anything I have ever seen. I say get a new job and fast!!

Yes, it does matter. This is how you make the money and if you understand nothing else about the MDS/PPS, learn this. Do you have a RUG crosswalk? If not, ask your corporate MDS nurse, she or he should have one. Think of this as the bookmark for your RAI bible.

yes, that is correct. Never be too specific in a plan of care. If it changes, which it does frequently and no one gets to the CP to change it, you've got yourself an F tag.

It may be the "norm" these days as facilities are struggling to make and save money however able. The problem is, they need to take a step back and realize that the MDS or PPS nurse (THE REIMBURSEMENT NURSE) should do only that. Nothing else. When you have nurses doing MDS when they are not familiar with either the RAI or the residents, this leads to coding errors, coding errors lead to lost revenue either immediately or in the future when MCR or MCD audits and takes back money.

just keep in mind that you may not move the ard date once an assesment window has closed, or if you have already picked an ard date and that date has passed. example: last quarterly r2b was 2/1/09, rug = pa. next quarterly r2b would be due on or before 5/3/09, probably w/ an ard set on 4/20 or later. resident was seen by a dentist on april 1st with an order to keep denture off for 2 days. on april 3, the opthalmologist saw resident for his glaucoma follow-up and change his eye meds. these would equal to 2 md visits and 2 md orders. since your ard begins on 4/20, you would have missed these events based on the 14 day lookback for p7 & p8. however, if you move the assm't earlier and set the ard on or before 4/14, you will capture the visits/orders and raise the quarterly rug score to ca. have a cheat sheet similar to this and memorize what conditions yield a higher rug. be present during the daily 24 hr. report and check if a resident has an acute change in clinical condition or may have required more staff assistance in adls during the week. when is his next assm't due? most important, choose ards wisely. be flexible. schedule it later or earlier depending on what conditions or better adl sum you can capture that will produce a higher rug. just remember you have to complete the assessment (r2b) within 14 days of the ard, and, that r2b is within 92 days of the last assm't's r2b.

Treat every payor source as if it were medicare or medicaid. This will save you a lot of pain in the long run when you find out that the resident was actually medicare and NOT private insurance.

Exactly what was said previously. Do not care plan for the state, care plan for the resident. You will never master what the state is looking for because, A) It varies B)It depends on the surveyor and what type of mood they are in. In a nutshell, care plan problems or potential problems. Do not care plan diagnosis, the doctor has already directed the plan of care for those. Do not care plan medications unless you are care planning polypharmacy or psyhcotropics. If the patient is recieving coumadin, prednisone etc.; care plan this under skin integrity - ie: potential for bruising, poor wound healing, skin tears etc. Care plans must be written in simple form. In a format that a CNA can read and understand. Hope this helps.

I want to just clarify the reply i made yesterday. When I say write your own note if you have to, what i mean is after talking with direct care staff, document what they say. Just make sure you do it before the ARD so you can count it.

ADL's are by far the most miscoded item. Behaviors as well. You must do education continuously with your nurses and CNA's. I don't know what kind of program you have, but the one I use calculates the ADL score when it calculates the RUG. I think most of them do. Pay attention to your ADL score. If it is 7, or 15 - search for just one piece of information that will bring that ADL score up one more point. Search documentation, ask direct care staff and document yourself if you need to. Bringing the ADL score up one more point will increase your RUG score, therfore, increasing CMI and revenue.

The fact is, it is different in every building. I have been in buildings where medical records was responsible. I am currently employed as a PPS Coorinator and it is my job. As far as them being late, there is a place on the certification to explain why it was late. Put your blurb in there. If there is no reason, no good reason anyhow, you cannot legally bill medicare.

You're right, we do careplan potential problems but taking nine or more medications does pose a potential problem, that's why it is a quality indicator. Not sure about other states - but Kansas wants to see this careplanned...if not there, they are likely to tag us. There are certainly alot of things that we careplan that are ridiculous. This may be one of them, if you do have to careplan this, I hope my post will help.

I am sure that I am beating the dead horse here but the question still remains. What happened to nursing? I have been a practicing LPN for greater than 14 years. In this short amount of time, I have gone from nurse to secretary, private investigator, detective, lawyer and oh, let me not forget...maintenance man. Don't our patients deserve more? Listen, I am not sure about the other states but I can tell you that the State of Kansas has made it impossible to practice nursing. Instead of spending 8 or 12 or even 16 hours taking care of the ill, we instead spend the time covering our you know whats. I continuously find myself running away from the patients so I can finish the twenty tons of paperwork that I have waiting for me on any given day. I know this is kind of jumping all over the place but I am just wondering when a bruise on someone who is 80 or 90 years old automatically became a reason to investigate for abuse of neglect. They are elderly, they bruise, that's just what they do. Their skin is xerotic and it tears easily. If they have dementia on top of that scratch or bruise and they are not able to tell you how it got there, you're really in trouble - now you have a report to call into the state. Most of the time when I get a bruise, I don't know how I got it - I am 35! Since we're on the topic, why in the world does every single complaint have to be a logged "grievance." A patient doesn't like the food one evening so he or she complains and bang!!! A grievance that requires hours of paperwork. A family member complains that a nurse is not doing his or her job as they think it should be done...oh yes, you've got it..another grievance. Someone falls because they have dementia and have just broken a hip. They don't remember that they are not able to walk on their own - now...an incident report. I can understand the need for this one but isn't a single page enough? Why must we repeat the same thing on five different pieces of paper and then do it again in the nurses notes. God for bid if you have to perform neuro checks!! You are so busy being a broken record that there is no time for that. NO time for the patient!!! And whatever you do, don't let a patient lose weight - even if they weigh 500 pounds because you will be neglecting them. I do agree that the State and Federal governments were wise in putting some programs and regulations into place to prevent or identify abuse of neglect but they have gone just a little too far. They have taken away our job, our vocation, our morals, values and dreams. They have left patients to fend for themselves. The have forced us to sit at a desk. I wonder when they will wake up? To end my bitter paragraphs, I just want to say that we are certainly not paid enough for what we do and the risks that we take everyday nor are we recognized enough. I wish I had a foghorn so I could shout it to the world. Put us right up there with police officers and fire fighters because this is what we are and this is where we belong!!!

We have to careplan for this as well. This is a quality indicator and if it is not careplanned you are likely to get a tag. At least here in Kansas. My careplan goes something like this; problem: Potential for complications related to multiple dx's as evidenced by recieves greater than nine medications routinely. Goal; Mr. so and so will recieve therapeutic effect of all medications and will have no adverse effects. Approaches: pharmd to review meds monthly (in ks); observe for s/s that may be indicative of adverse effect; labs as ordered; vs as ordered; any special instructions such as rinsing mouth or take with 8 oz. of water etc. Hope this helps

I agree whole heartedly!!!! It's like this; NURSE= ONE WHO CAN BE VERBALLY ABUSED AT ANY TIME AND FOR ANY REASON. THERE WILL BE NO REPRECUSSIONS. (Did i spell that right?) Anyhow, I too wish there was a way to scream to the world about this very same thing. Just because we are nurses does not mean that we are not human beings. Alot of the time, people don't understand that we too have feelings. I do understand that there is a certain amount of customer service crap that we must put up with but I also believe there is a very fine line. I am lucky that in my job, we do have the support of our managers. I have decided after 18 years of doing this that I will NOT allow people to cross that line with me, patients, family members or otherwise. We DO have the right to be respected just like the next person. Demand it and you will get it.

Get a new job

Hi everyone!!! I will be moving to katy a month from now. Looking for a good job that pays decent. Anyone have any ideas? I am an LPN with greater than 16 years exp. Currently Nurse manager/MDS coordinator for LTC facility. Exp. in psych and corrections as well. Willing to consider any of these areas. Thank you

I dont know if they still teach this but use SOAP notes. Subjective, Objective, Assessment and Plan. What the pt. says, what you see, your assessment of what you see and do and what you plan to do. This is very easy. Another thing I do is just go from head to toe. Ie: mental status all the way down to ambulation and edema in the lower extremities. -One thing that an "old" nurse can advise you and probably the most important thing I can tell you is DOCUMENT DOCUMENT DOCUMENT!!!! Everything always. Take credit for what you do, even if a patient is not having problems, document that. it will save you in the long run. When documenting, think of sitting next to the man in the black robe with a lawyer pounding you for answers. The answers should be in your documentation, if it's good.